Systematic review: What is the best first-line approach for cesarean section ectopic pregnancy?
This systematic review aims to analyze the case reports, case series, or clinical studies describing the women with cesarean scar ectopic pregnancy (CSEP), and thus, to determine the efficacy and safety of different primary treatment modalities in the management of CSEP. A thorough search of electro...
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| Format: | Article |
| Language: | English |
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Elsevier
2016-04-01
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| Series: | Taiwanese Journal of Obstetrics & Gynecology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1028455916000395 |
| _version_ | 1818320270627176448 |
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| author | Mine Kanat-Pektas Serkan Bodur Ozgur Dundar Vuslat Lale Bakır |
| author_facet | Mine Kanat-Pektas Serkan Bodur Ozgur Dundar Vuslat Lale Bakır |
| author_sort | Mine Kanat-Pektas |
| collection | DOAJ |
| description | This systematic review aims to analyze the case reports, case series, or clinical studies describing the women with cesarean scar ectopic pregnancy (CSEP), and thus, to determine the efficacy and safety of different primary treatment modalities in the management of CSEP.
A thorough search of electronic databases showed that 274 articles on CSEP were published between January 1978 and April 2014.
Systemic methotrexate, uterine artery embolization, dilatation and curettage (D&C), hysterotomy, and hysteroscopy were the most frequently adopted first-line approaches. The success rates of systemic methotrexate, uterine artery embolization, hysteroscopy, D&C, and hysterotomy were 8.7%, 18.3%, 39.1%, 61.6%, and 92.1%, respectively. The hysterectomy rates were 3.6%, 1.1%, 0.0%, 7.3%, and 1.7% in CSEP cases that were treated by systemic methotrexate, uterine artery embolization, hysteroscopy, D&C, and hysterotomy, respectively. The ability to achieve a subsequent term pregnancy is related to successful systemic methotrexate treatment (p = 0.001) or hysterotomy (p = 0.009). Future term pregnancy was significantly more frequent in the hysterotomy group (p = 0.001).
Hysteroscopy and laparoscopic hysterotomy are safe and efficient surgical procedures that can be adopted as primary treatment modalities for CSEP. Uterine artery embolization should be reserved for cases with significant bleeding and/or a high suspicion index for arteriovenous malformation. Systemic methotrexate and D&C are not recommended as first-line approaches for CSEP, as these procedures are associated with high complication and hysterectomy rates. |
| first_indexed | 2024-12-13T10:22:21Z |
| format | Article |
| id | doaj.art-a2dcf3628741495ab1326119f633ae76 |
| institution | Directory Open Access Journal |
| issn | 1028-4559 |
| language | English |
| last_indexed | 2024-12-13T10:22:21Z |
| publishDate | 2016-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Taiwanese Journal of Obstetrics & Gynecology |
| spelling | doaj.art-a2dcf3628741495ab1326119f633ae762022-12-21T23:51:09ZengElsevierTaiwanese Journal of Obstetrics & Gynecology1028-45592016-04-0155226326910.1016/j.tjog.2015.03.009Systematic review: What is the best first-line approach for cesarean section ectopic pregnancy?Mine Kanat-Pektas0Serkan Bodur1Ozgur Dundar2Vuslat Lale Bakır3Department of Obstetrics and Gynecology, Afyon Kocatepe University Medical Faculty Hospital, Afyonkarahisar, TurkeyDepartment of Obstetrics and Gynecology, Beytepe Military Hospital, Ankara, TurkeyDepartment of Obstetrics and Gynecology, Gulhane Military Academy of Medicine Haydarpasa Military Education Hospital, Istanbul, TurkeyDepartment of Obstetrics and Gynecology, Haseki Education and Research Hospital, Istanbul, TurkeyThis systematic review aims to analyze the case reports, case series, or clinical studies describing the women with cesarean scar ectopic pregnancy (CSEP), and thus, to determine the efficacy and safety of different primary treatment modalities in the management of CSEP. A thorough search of electronic databases showed that 274 articles on CSEP were published between January 1978 and April 2014. Systemic methotrexate, uterine artery embolization, dilatation and curettage (D&C), hysterotomy, and hysteroscopy were the most frequently adopted first-line approaches. The success rates of systemic methotrexate, uterine artery embolization, hysteroscopy, D&C, and hysterotomy were 8.7%, 18.3%, 39.1%, 61.6%, and 92.1%, respectively. The hysterectomy rates were 3.6%, 1.1%, 0.0%, 7.3%, and 1.7% in CSEP cases that were treated by systemic methotrexate, uterine artery embolization, hysteroscopy, D&C, and hysterotomy, respectively. The ability to achieve a subsequent term pregnancy is related to successful systemic methotrexate treatment (p = 0.001) or hysterotomy (p = 0.009). Future term pregnancy was significantly more frequent in the hysterotomy group (p = 0.001). Hysteroscopy and laparoscopic hysterotomy are safe and efficient surgical procedures that can be adopted as primary treatment modalities for CSEP. Uterine artery embolization should be reserved for cases with significant bleeding and/or a high suspicion index for arteriovenous malformation. Systemic methotrexate and D&C are not recommended as first-line approaches for CSEP, as these procedures are associated with high complication and hysterectomy rates.http://www.sciencedirect.com/science/article/pii/S1028455916000395cesarean scar ectopic pregnancyectopic pregnancytreatment |
| spellingShingle | Mine Kanat-Pektas Serkan Bodur Ozgur Dundar Vuslat Lale Bakır Systematic review: What is the best first-line approach for cesarean section ectopic pregnancy? Taiwanese Journal of Obstetrics & Gynecology cesarean scar ectopic pregnancy ectopic pregnancy treatment |
| title | Systematic review: What is the best first-line approach for cesarean section ectopic pregnancy? |
| title_full | Systematic review: What is the best first-line approach for cesarean section ectopic pregnancy? |
| title_fullStr | Systematic review: What is the best first-line approach for cesarean section ectopic pregnancy? |
| title_full_unstemmed | Systematic review: What is the best first-line approach for cesarean section ectopic pregnancy? |
| title_short | Systematic review: What is the best first-line approach for cesarean section ectopic pregnancy? |
| title_sort | systematic review what is the best first line approach for cesarean section ectopic pregnancy |
| topic | cesarean scar ectopic pregnancy ectopic pregnancy treatment |
| url | http://www.sciencedirect.com/science/article/pii/S1028455916000395 |
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